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Procedural burden experienced by children with cancer during their terminal hospital admission
Kristine S Corkum1, Timothy B Lautz1, Ferdynand N Hebal2
1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
Children with cancer undergoing terminal hospital admission (THA) frequently receive invasive procedures. Many undergo multiple major operations, highlighting the need for careful end-of-life care discussions.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Medical Ethics
Background:
- Children with chronic conditions, including cancer, often receive intensive end-of-life care.
- Understanding the extent of invasive procedures during terminal hospital admissions (THA) for pediatric cancer patients is crucial.
Purpose of the Study:
- To assess the frequency and timing of invasive procedures in children with cancer during their THA.
- To identify the types of major operations performed and their proximity to death.
Main Methods:
- Retrospective cohort review of the Pediatric Health Information System database (2011-2015).
- Inclusion of patients aged 1-18 years with a malignancy flag who died in-hospital.
- Categorization of invasive procedures into major operations and minor procedures.
Main Results:
- 2210 pediatric cancer patients had a THA.
- 64.4% underwent at least one invasive procedure, and 60.1% had three or more.
- 21.1% underwent 780 major operations, including ventriculostomy/shunt placement and intracranial mass excision.
- 21.7% of those undergoing major operations died within 48 hours of surgery.
Conclusions:
- Pediatric cancer patients dying in-hospital face a significant procedural burden before death.
- There is a need for multidisciplinary discussions on the necessity of invasive procedures.
- Surgeon involvement in end-of-life care decisions for these complex cases is recommended.
Background:
Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA).
Methods:
The Pediatric Health Information System database was queried from 2011 to 2015 for patients ages 1-18 years with a "malignancy" flag who died in the hospital. Patient demographics, admission details, procedures codes, and date of service were extracted. Invasive procedures were categorized into 'major operations' or 'minor procedures'.
Results:
2210 children with cancer were identified as having a THA. During the THA, 1423 (64.4%) patients underwent an invasive procedure and 856 (60.1%) of those children underwent three or more procedures. 466 (21.1%) patients underwent a total of 780 major operations. The most common operations were ventriculostomy/ventriculoperitoneal shunt (n = 211), intracranial mass excision (n = 60), bowel resection (n = 56), and exploratory laparotomy/laparoscopy (n = 46). 101 (21.7%) patients who underwent a major operation died within 48 h of surgery.
Conclusions:
Children who have cancer and die in the hospital face a large procedural burden prior to their death. This study highlights the need for open, multidisciplinary discussions regarding the necessity of these procedures and for surgeon involvement in complex end-of-life care decisions.
Type Of Study:
Retrospective cohort review.
Level Of Evidence:
Level IV.
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